text:
France Newsletter
Sign up to our weekly newsletter with TechCrunch's best posts of the week covering the French tech ecosystem: http://tcrn.ch/1m5t5UQ
Lima Showcases Its Mobile App For Its Dropbox Alternative
French startup Lima is presenting another piece of its offering at CES, the mobile app. And it is a very promising app for those who backed Lima to seamlessly access their photos, music library and movies from their phones and tablets. While the team still needs to polish the app interface, it goes beyond Dropbox and Carousel when it comes to features. As a reminder, Lima is a small device… Read More
Happn Attracts $8 Million To Roll Out Its Tinder-Like App Globally
French dating app Happn just raised an $8 million Series A round from Alven Capital and DN Capital, as well as business angels, such as Fabrice Grinda. As a reminder, Happn uses your phone's location to show you potential matches. Every time you cross someone's path, this person's profile will be added to the top of your feed. Then, you can like people and potentially… Read More
French Uber Competitor SnapCar Grabs $2.5 Million And Pivots To B2B
French Uber competitor SnapCar just raised $2.5 million (€2 million) from business angels, such as former global CEO of American Express Travel Charles Petruccelli and Bertrand Mabille. While the company already has more than 200 corporate clients, it is focusing on B2B for good. SnapCar works more or less the same way as competitiors, such as Chauffeur-Privé, LeCab and Uber, but… Read More
Vidcoin Solves Buffering Issues For Mobile Video Ads
Vidcoin is an advertising technology startup focused on video ads for smartphones. The French startup makes watching video ads less painful by providing an SDK that will buffer videos before playing them so that they will instantly play. "Mobile video continues to be a challenge for one simple reason: mobile connectivity can be spotty so the type of streaming videos [companies like… Read More
Addr Is A Nifty iPad Ebook Reader For Those Who Miss Readmill
Meet Addr, a brand new iPad app to read your ePub ebooks. In some way, Addr is very reminiscent of Readmill's now defunct ebook reader. It's all about importing your DRM-free ebooks and adding a social layer to take annotations and share them with your friends. But the comparison stops there as Addr is a very different take when it comes to design. First, the app goes a bit… Read More
Capitaine Train Grabs $6.3 Million To Build The Best Service To Book Train Tickets
There is nothing as cool as riding a high-speed train across Europe. But buying train tickets is also one of the worst online experiences. French startup Capitaine Train is all about making this process as seamless and complete as possible. The company just raised another $6.3 million (€5.5 million) to expand its activities. Read More
Le Wagon Is An Impressive French Coding Bootcamp For Entrepreneurs
Coding bootcamps are nothing new, but they have always been more popular in the U.S. than in Europe. Last year, when Le Wagon started, it was a breath of fresh air. The team not only wanted to bring the concept back to Europe, but also wanted to add its own flavor. Le Wagon is a coding school specifically targeted towards entrepreneurs. It designs its own high quality content to make you… Read More
Batch Insights Is AppGratis' New Trick, A Benchmark Tool For Push Notifications
The two co-founders behind AppGratis are working on a new project for mobile developers. Batch Insights is a push notification aggregator that will let you search, filter and manipulate notifications from thousands of popular apps. This service is a good way to benchmark your competitors when it comes to push notifications. "With Batch Insights we're on a mission to index all… Read More
Prizm Plays Music You Like To Transform Your Living Room Into Your Favorite Coffee Shop
Remember the last time you went to the same coffee shop or bar because the staff tends to play music you like and you don't have to pick the next song? Prizm is a neat little pyramid add-on for your sound system to transform your living room into this coffee shop you like. The French startup is just beginning the last week of its Kickstarter campaign of its $129 smart music player for… Read More
With Vyte.in, Schedule Meetings Without Long Email Threads
Scheduling a meeting usually takes a few emails. Add a third person, and you are now stuck in an email nightmare. French startup Vyte.in knows this too well, and will let you schedule meetings in a few clicks right in your browser. "I've worked for 4 years in big companies and small startups — from the smallest to the biggest company, you always have this problem when it comes… Read More
Glose Is A New Ebook Reader That Turns Reading Into A Social Experience
Meet Glose, a brand new ebook reader for your phone, tablet and laptop. Glose is like the Kindle apps, but on steroids. Reading a book in Glose becomes a collective experience as you can discuss quotes with your friends and other Glose users, keep notes and more. You can also browse a feed of your friend's annotations to get a taste of books you have yet to read. At heart, the team wants… Read More
Online Labs Designed Its Own ARM Servers To Take On AWS, DigitalOcean
A couple of years ago, the team behind Online Labs started a long ambitious project — instead of building a virtual cloud hosting infrastructure that competes directly with Amazon Web Services, DigitalOcean and other VPS providers, it designed its own hardware for its cloud solution. Online Labs managed to squeeze 912 separate computers in a single server rack. But the best part is that… Read More
Clustree Automagically Matches Internal Talent With Job Positions
Meet Clustree, a French startup that uses big data to find the right person for the right position within big companies. Clustree will help both good employees who feel stuck in their jobs and HR departments who might not think to check their own companies for the perfect candidate. "Clustree is a SaaS platform for talent management," founder and CEO Bénédicte de Raphélis… Read More
Agorize Bags $2.6 Million To Crowdsource Business Ideas With Open Innovation Challenges
When your company wants to find a comprehensive answer on a particular topic, you often end up paying another company to create and handle a marketing survey or rely on Amazon Mechanical Turk. Meet Agorize, a company that relies on open innovation and community crowdsourcing to let companies gather a lot of data on new ideas and ventures. It raised $2.6 million from Iris Capital and… Read More
B4RM4N Is A Smart Shaker That Turns The Art Of Cocktail Mixing Into A Science
Meet B4RM4N, a smart connected shaker to pretend that you actually know how to mix cocktails. B4RM4N connects to your phone using Bluetooth and will tell you exactly what to do to make the perfect cocktail. And the best part is that you get feedback in real time to tell you precisely when to stop pouring. B4RM4N will cost you between $89 and $159 depending on how early you back the… Read More
La Belle Assiette Gets $1.7 Million To Scale Up Its On-Demand Chef Service
French startup La Belle Assiette just raised $1.7 million (€1.3 million) from angel investors, such as BlaBlaCar's Nicolas Brusson, eFounders' Thibaud Elzière, Nicolas Bourdin, the three founders of l'Atelier des Chefs and Kima Ventures. As a reminder, with La Belle Assiette, you can browse and find the perfect chef for your lunch or dinner party. He or she will then… Read More
BlaBlaCar CEO Frédéric Mazzella Will Talk About France's Next Unicorn At Disrupt Europe
For our international audience, last July, BlaBlaCar popped out of nowhere and scored a massive $100 million round led by Index Ventures. Frédéric Mazzella's startup is creating a global ride-sharing marketplace for long distance rides — and it's working. His story is one of the most impressive comeback story of the French tech ecosystem. We are very lucky to welcome him… Read More
Shared Inbox Front Pulls $3.1 Million To Optimize Your Email Workflow
Front is the front desk of your company. Whenever someone sends an email to your contact@, jobs@ or support@ email addresses, the email will appear in your team member's Front accounts. Then, instead of forwarding the email, creating group emails and forgetting to CC someone, it works like a modern task manager. You can assign an email to someone, comment, get notifications and more. Read More
Parrot's New Zik 2.0 Headphones Are Perfect For Hipsters
Parrot is better-known for its drones, but the company just announced brand new high-end headphones, the Zik 2.0. They are colorful, feature-packed and different. You can tweak sound settings for each and every different song so that they sound closer to the perfect sound for your ears. In other words, it's a hipster's dream. Like its predecessor, the Zik 2.0 is a Bluetooth pair… Read More
With New Ad Publishers On Board, Appsfire Becomes A Solid Alternative Mobile Advertising Network
Advertising technology startup Appsfire provides some of the best interactive advertising formats on mobile devices. Yet, on mobile, Facebook, Google and now Twitter seem to be the overwhelmingly dominant advertising networks. To counter this idea, Appsfire just announced some of its first advertising publishers, and it looks like the startup is becoming a solid alternative network. When I… Read More


text:
Analysis: A speech more about diplomacy than terror
Erdan: Government must express its sovereignty in Arab neighborhoods of Jerusalem
Israel to world leaders: Urge Palestinian Authority to stop incitement
Opposition parties not joining coalition despite terror
Fasten your seat belts!
Blues Brothers and Booker T. Jones to calm frazzled Israeli nerves
Israeli designers shine at NYC Bridal Week
Concert Review: Dudu Fisher and Colin Schachat
Hap TA, Rishon get league campaigns off to promising starts
Belgian miracle needed for blue-and-white
Strong 6th for Israeli golfer Beck at Symetra Tour IOA Classic
Israeli surfers still hoping to compete in Oman
Settlers plan to drive protest convoy to Jerusalem Tuesday
One injured in stabbing attack in Ra'anana
Analysis: A capital on edge
Joint List's Odeh calls on Arabs to mobilize for successful strike Tuesday
Suspect in ramming, stabbing attack: It was a 'car accident'
Four terrorist attacks rock Jerusalem over 12 hours
Israeli students attacked with firebomb in Manhattan
Yesh Atid, Shas Lawmakers working to dissuade divorce refusal in the Diaspora
Jewish cemetery in Poland dug up in quest for gold, says NGO
Yemenite government to Jews: Convert or leave Yemen
Ohio to pass anti-BDS law
Iranian parliament passes bill approving nuclear deal
Washington Post reporter Rezaian convicted, Iran news agency says
Iran tests new precision-guided ballistic missile
Sources: US warns governments, bankers Iran sanctions still in place
'ISIS is prime suspect in Turkey bombings that killed 97'
Iraqi air force: We hit convoy of ISIS leader Baghdadi
ISIS vs. al-Qaida: Zawahiri says Baghdadi is not the leader of the Muslim world
'ISIS militants blow up ancient Arch of Triumph in Palmyra'
Breast Cancer Awareness Month: Hadassah fights BRCA with decorated bras
Barzilai gets medical administration degree recognition
Offbeat odor
How to cope with holiday's excess calories and winter's illnesses
Adam Teva V'Din demands broad energy efficiency program
Antitrust Authority eases restrictions on search for additional natural gas fields
Cabinet approves plan to transfer KKL-JNF funds to ministry
Still too soon to determine production potential of Golan Heights oil
Israelis compete to dream up car of the future in TA hackathon
Israeli parking app, coming to a university near you
Tech talk: Battle Hacks are back
Facebook pegs Israeli satellite to provide African Internet
'Secret Tel Aviv' in the time of stabbing attacks
Jerusalem's King David Hotel prepares for Indian president's visit
Grapevine: Mission Accomplished
This week in 60 seconds: Terror hits Israel
Grapevine: Labor of love
ISIS – the international 'whitewasher'
Dismantling the Oslo Accords also dismantles Israeli-PA cooperation
Hope amid the storm in Tel Aviv
Kahlon, keep recruitment in our hands
Borderline views: Border tourism in Israel, Korea, Germany and India
Who is a hero?
The diplomacy profession
Coexistence in a cone
2016 Budget: Not just numbers
The good doctor's advice
Courage, rabbis, courage!
Fresh cooking tips from France
Meandering along the Rhine River, soaking up the rich Jewish heritage
Food does grow on trees
A treasure trove of historical posters
Is your dog Jewish?
Ironic Mother Earth
Neighborhood Watch: Regenerating Safed
Cancer Chronicles: Side effects
Feeling uneasy at the moment?
Lonely vigil
מִשִירֵי רָחֵל: זֶמֶר נוּגֶה
אֲנַחְנוּ הַיִשְׂרְאֵלִים
אֲנִי בְּחוֹפֶש, תִסְתַדְרוּ לְבַד
Living in a shoebox
Building health in Rwanda
'The Sabbath is on Saturday not Sunday'
Born to dance
True Love
When Peace Becomes Personal
The Man Who Found the Menorah
American Dreams Gone Awry
Honoring Zakarpatia-Transkarpathia Jewry in Ben Shemen Forest
North American Fallen Remembered at AACI Memorial Forest
Inauguration of the Masonic Forest Square in Jerusalem
Free Schach Distribution in KKL-JNF Forests
greenXchange at EXPO Milano
First Tree after Shmita Year Planted by Bavarian Agriculture Minister
Prime Minister of Lithuania Plants Tree in Jerusalem
KKL-JNF International Expo Mission to Milan
Agriculture Festival at Hula Lake Park
An Ecological Festival at the Shafir Winter Pond
KKL-JNF Global Landscapes Seminar at Expo 2015
New Bio-filters Purify Surface Runoff Water for Reuse
Got Water Problems?
$100 Million JNF Boruchin Israel Education Advocacy Center Opens
JNF Canada Pays Tribute to the Honourable John Baird
From Sunny Israel to Cold Canada
Renewable Energies for the Future in the Arava
LDA Conference: Science and Technology for Forests
The Negev Conference on Agricultural Research and Development
Arava Open Day: Food Security for Israel and the Entire World
Melinda and Chelsea: The Inspiring Story of Aliyah Across the Ages
An Olah Reports From Nepal
How One Oleh is Helping to Transform the Way People Drink Water
From Think Tank to Environmental Consultant
Why People Love Volunteering in Israel
How Natalie Edwards Built a Successful Career in Israel's Startup Industry
5 Tips to Land a Job in Israel
Starting Your Own Business in Israel: Real Life Examples
Where Are They Now? The Olim of the July 2014 Charter Flight
36 Hours in Southern Israel
Food Shopping In Israel
How Women Can Have it All in Israel
Why Retirees are Thriving in Israel
Thanks to Aliyah video
6 Frequently Asked Questions about Israeli Healthcare
Starting Over in Israel
Spotted on Social: Moshe Somers' Activity List
Sam Eisenberg: From Nativ to Aliyah
WATCH: Why Olim #LiveLoveIsrael
5 Ways that Olim Kick Back
WATCH: Highlights of 221 Olim Landing on the July 2015 Charter Flight
"WATCH: Highlights of 232 Olim Landing on the August 2015 Charter Flight"
Make yourself at home… in Israel
10.13.2015 | 30 Tishri, 5776
Russia claims to foil Islamic State plot on Moscow
Obama's ex-pastor: Israel is apartheid state, 'Jesus was a Palestinian'
Hundreds face off in Australian town in anti-Islam protest
Ben Carson: Tragedy of Holocaust could have been greatly minimized should the Jews have been armed
Germany's Jewish community head fears Muslim migrants' anti-Semitism
US airstrike kills at least 19 in Afghan hospital run by aid group
Israeli man killed in New York elevator tragedy
Gunman kills 9 at Oregon college, dies in shootout with police
Council of Europe cancels anti-circumcision measure after joint Jewish-Muslim effort
Huge Nazi banner for film causes outcry in France
Hindu mob lynches Indian Muslim rumored to have killed a cow
Suspected Islamist rebel faces ICC for destruction of Timbuktu Muslim heritage sites
08/06/2010 02:18
Lebanese Soldiers 311.
(photo credit:Associated Press)
WASHINGTON – The distinction between the Lebanese Army and Hizbullah has become
"cloudy" and advanced weaponry given to the Lebanese military could find its way
to the Islamist group, Ambassador to the US Michael Oren warned on
Wednesday.But Oren, when asked on a conference call whether the US had
any plans to stop providing arms and assistance to the Lebanese Army, said
"there's no indication yet" of that happening.RELATED:Editorial: Attacked by LebanonOpinion: Right and wrong in LebanonEditorial: The US has it wrong on LebanonEarlier on Wednesday, US
State Department spokesman P.J. Crowley defended American assistance to the
Lebanese military despite its shooting of two IDF officers, killing one and
seriously wounding the other, as they cut down a tree along the northern border
on Tuesday. The IDF returned fire and killed two Lebanese soldiers and a
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subset: commoncrawl


text:
|Publication number
|Publication type
|Application number
|PCT number
|Publication date
|Aug 28, 2003
|Filing date
|May 9, 2001
|Priority date
|May 10, 2000
|Also published as
|Publication number
|Michael O'Malley, Michael Bell, James Lee, Leonard Lee
|Original Assignee
|O'malley Michael T, Bell Michael S G, James Lee, Lee Leonard G
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (5), Referenced by (45), Classifications (11), Legal Events (2)
|External Links: USPTO, USPTO Assignment, Espacenet
[0001] This application claims priority to Provisional Application Ser. No. 60/202,739, filed May 10, 2000, entitled "Wound Closure System and Method," and to Provisional Application Ser. No. 60/249,766, filed Nov. 17, 2000, entitled "Wound Closure System and Method."
[0002] This invention relates generally to the moving and stretching of human and animal plastic tissue and more specifically to a system and method of moving and stretching plastic tissue using dynamic force.
[0003] Elastic tissue returns to a minimum elastic, or relaxed, state when released from tension. In this relaxed state, tissue cells have a spherical shape, cell walls are thick and strong, and cell surface tensions are minimized and balanced. A cell in this minimum elastic state will remain relaxed, demonstrating behavior similar to a non-elastic material. The force required to elongate a cell in this state often approaches a force that will rupture or sheer intercellular bonds, causing localized failures or tears. Soft tissue in this minimum elastic state provides minimum surface coverage and has the highest reluctance to stretch. It is believed that a gentle but constant force below the sheer force threshold applied to tissue in combination with adequate hydration will, over time, restore the skin to the original elastic state. Additionally, this force can be applied to stretch tissue past the point of equilibrium (normal elastic range) to the maximum elastic range and create the thinnest possible configuration, covering the maximum surface area. If intercellular pressures in the tissue do not exceed the point at which intercellular bonds are compromised, the tissue remains at the maximum elastic state as healthy tissue, and normal biological processes will build additional cells to restore normal skin thickness and tension, which is described below as biological creep.
[0004] Plastic tissues, such as skin and muscle, possess certain viscous and elastic rheological properties, and are therefore viscoelastic. Certain plastic tissues are able to increase surface area over time, which is described as "creep." Mechanical creep is the elongation of skin with a constant load over time, while biological creep refers to the generation of new tissue due to a chronic stretching force. A constant and unrelenting force applied a body tissue, such as skin or muscle, may result in both mechanical and biological creep. Mechanical creep restores the tension originally present but lost in the skin across the incision or wound by retensioning skin or soft tissue cells, thereby increasing skin coverage. Biological creep occurs more slowly and involves the creation of new tissue. Tissue expansion has long been part of the art of plastic surgery, traditionally accomplished with balloon-type tissue expanders embedded under the skin and externally inflated and increased over the to create expanded pockets of skin for procedures such as breast reconstruction after radical mastectomies, and stretching healthy tissue prior to plastic surgery for the creation of flaps for soft tissue closure.
[0005] Wound management, including treatment and care of large skin defects and severely retracted incisions, is an area of increasing importance in medicine today. There are many types of wounds and conditions that require treatment, including, but not limited to: diabetic ulcers and other chronic ulcers; venous stastis ulcers; pressure sores or ulcers; burns; post traumatic lesions, such as post disarticulation, post debridement, cutaneous gangrene, post colectomy, crush wounds with ischemic necrosis; collagen disease, including rheumatoid arthritis; vasculitis (lesions and ulcers caused by arterial insufficiency); amputation; fasciotomy; abdominal surgery; post sternotomy; necrotising fasciitis; trauma; wounds having exposed plates or bones; scar revision; skin lesions; bariatric surgery; blunt abdominal trauma with perforations; pancreatitis; neuropathic ulcers; compartment syndrome; and other subacute or chronic wounds. Treatment and care of these defects is challenging due to difficulties in closure of open wounds.
[0006] Compartment syndrome is a condition in which increased pressure in a limited space compromises the circulation and survival of the tissues within that space. Elevation of interstitial pressure in a closed facial compartment results in microvascular compromise within the compartment and vascular insufficiency, reducing blood flow. Capsulated internal pressure is created when swelling exceeds the elastomeric capacity of the skin. This condition is commonly caused by capillary infusion following, for example, trauma, inflammation, burns or intense muscle use. As duration and magnitude of interstitial pressure increase, necrosis of soft tissues eventually develops. If left untreated, it can lead to permanent injury to muscle, nerve and vascular structures, resulting in major loss of function, limb, and even life. These types of permanent injuries resulted in amputations prior to the development of aggressive treatments.
[0007] Objectives of treatment of compartment syndrome include minimizing deficits in function by promptly restoring local blood flow. This can be accomplished through surgical decompression, which consists of pressure release by an expedient fasciotomy in which each potentially limiting envelope, including skin, is opened over the entire length of the compartment. Expedient fasciotomy provides room for tissue expansion, which results in an instant relief in pressure, restores normal vascular function, and minimizes tissue death that would result from restricted circulation. The skin is left open after surgical decompression to prevent it from becoming a limiting envelope during the anticipated period of post-ischemic swelling. This large, open incision allows the engorged tissues to expand beyond normal dermal restriction and resume normal pressures. Over time, fluid is reabsorbed and tissues return to a pre-trauma size. In many cases, skin closure may be attempted three to five days after surgical decompression by direct suture or meshed skin graft. However, the elastomeric properties of the skin cause wound edge retraction over time, and make closure difficult or impossible. Objectives for closure of other wounds and skin defects are similar to those for closing a fasciotomy.
[0008] Two common methods of closure of wounds and skin defects include split thickness skin grafting and gradual closure. A split thickness skin graft involves removing a partial layer of skin from a donor site, usually an upper leg or thigh, and leaving the dermis at the donor site to re-epithelialize. In this manner, a viable skin repair patch can be transferred or grafted to cover a wound area. The graft is often meshed, (which involves cutting the skin in a series of rows of offset longitudinal interdigitating cuts) allowing the graft to stretch to cover two or three times greater an area as well as provide wound drainage while healing. Normal biological function of the skin heals the holes after the graft has been accepted. A meshed graft of this type requires a smaller donor area than a conventional non-meshed or full thickness skin graft. However, these methods do not provide optimal cosmesis or quality of skin cover. Other disadvantages of this method include pain at the donor site, creation of an additional disfiguring wound, and complications associated with incomplete "take" of the graft. In addition, skin grafting often requires immobilization of the limb, which increases the likelihood of contractures. The additional operation and prolongation of hospital stay is an additional economic burden.
[0009] Gradual, or progressive, closure is a second method of closure. This technique may involve suturing vessel loops to the wound edge and drawing them together with large sutures in a fashion similar to lacing a shoe. In addition, the wound edges may be progressively approximated with suture or sterile paper tape. The advantages of this gradual, or progressive, technique are numerous: no donor site is required for harvest of a graft, limb mobility is maintained, and superior cosmetic result, more durable skin coverage, better protection from full skin thickness and the maintenance of normal skin sensation may all be achieved.
[0010] Existing devices for effecting a gradual closure have many disadvantages. Current methods and devices draw wound edges together using mechanical devices such as screw-actuated devices that require repeated periodic adjustment because a relatively small skin movement substantially eliminates much of the closure force. Widely used existing closure techniques involve use of relatively inelastic materials, such as sutures or surgical tape. Excessive tension may cut the skin or cause necrosis due to point loading of the tissue. Current solutions include suture bolsters, suture bridges, use of staples as anchors at the wound edge, and the use of ligature wire to distribute the load along the wound margins. These approaches all rely on static ribbon or suture material, which must repeatedly be readjusted in order to function effectively, and even with this constant readjustment, maintenance of near constant tension over time is difficult, if not impossible, to achieve. Widely used traditional gradual closure methods rely on static force through fixed distance reduction, and do not provide continuous or dynamic tension.
[0011] Many current methods of open wound reduction employ static or non-yielding devices such as sutures or hard approximators, which reduce the distance between the wound margins and rely on the skin's natural elasticity to compensate for movement. One problem with these devices has been that when they are at the point of being most effective, when the skin is at the point of maximum stretch, additional skin tension created through motion, such as breathing or walking, creates stress points where the mechanical fasteners meet the wound margins, causing tearing and wound edge necrosis. This has generally required patients to remain immobile during the course of treatment. Existing systems for treating animals need not consider cosmetic result to such a degree as the healthy patient typically masks the wound site with fur, but cosmesis is a critical criteria in the measurement of a successful result from the system in the human application.
[0012] One existing device for effecting closure of a wound utilizes a constant tension, low-grade force to draw wound edges together. This device, the Proxiderm™ system, includes a pair of hooks carried by a pair of sliders that move along a path pulled by a pair of springs. This spring device is enclosed in a plastic housing and is available in four models with different curvature. The sharp hooks used in this system may damage the skin. The constant force used is a dictated force that is not variable.
[0013] Other closure devices are described in U.S. Pat. Nos. 5,234,462 and 5,649,960 to Pavletic, which disclose the use of elastomeric material to approximate wound margins, including rubber bands and other types of compressive and non-compressive materials. A kit disclosed by Pavletic requires bonding to the skin with an adhesive and also requires periodic adjustment to tighten the straps. One embodiment uses hooks and elastic loops, which must be replaced with smaller elastic loops to maintain tension. Another Pavletic embodiment uses a motor power source to provide a tightening means. The Pavletic patents do not disclose a system that eliminates the need to adjust the tension repeatedly, or a system that is self-regulating and self-adjusting.
[0014] One currently used device is the Sure-Closure device, which consists of two surgical needles, two U-shaped lexan polycarbonate arms with hooks on the bottom surface, a threaded tension bar and a polycarbonate ruler. The needles are threaded along the wound margin, and each arm is positioned above a needle, with the hooks piercing the skin and engaging the needles. The tension bar is then locked, and tension can be adjusted using the screw.
[0015] Existing methods of gradual wound closure fail to provide an effective gradual closure that restores original skin tensions lost across the wound. For example, the Proxiderm™ system has a single tension of 460 grams. In many instances, such as with the elderly or with compromised skin, this force is too great, resulting in localized failures, tears and necrosis. Many current devices are cumbersome, restrict patient mobility, must be completely removed for wound dressing and cleaning, and are usable in a relatively limited number of situations because of size constraints. Many also require a surgeon for reinstallation after removal for wound dressing. Finally, current devices cannot readily be used for radial closure of wounds due to their limited ability to pull in a single direction along an overhead beam, thereby restricting their application to parallel pulls along the same axis.
[0016] There is a need for a system providing for manipulation and control of tissue tensions on a living person or animal, utilizing both stretch and creep to restore and move plastic tissues. What is needed is a method and device for moving and stretching plastic tissue that is simple, easy to use, relatively inexpensive, extremely versatile, self-adjusting and capable of exerting relatively constant tension over a certain distance and at various intersecting angles in complex geometrical wounds.
[0017] Methods, systems and devices of this invention move and stretch any plastic tissue. For example, this invention is useful in the dynamic closure of large or small dermal wounds, incisions, or defects that may be associated with a variety of conditions, as well as in the stretching of healthy skin in preparation for a skin graft or other procedure. This invention involves the use of an elastomeric driver that may be formed in rods, bands, loops, sheets, nets, wires, or tubes, or other structures that can be stretched and exhibit relatively uniform retraction force over a relatively substantial distance, and anchors for attaching the elastomer to the plastic tissue. In the most simple use, such as closure of fasciotomies, the invention can be used to restore retracted skin to its original position.
[0018] This invention may also be used to stretch skin to cover an area where some of the original skin has been lost, such as might be the case with a localized burn, ulcer, or contracture or to stretch skin prior to a skin graft, flap, or other plastic surgical procedure. Depending on age, general health, skin condition, degree of skin hydration, and other factors, most skin can be stretched about 20%. Under ideal conditions, skin can be stretched as much as 60% over a period of weeks. In rare circumstances, stretching as much as 100% is possible. The viscoelastic properties of skin are discussed in Willielmi, et al., Creep v. Stretch: A Review of the Viscoelastic Properties of Skin, 215 Annals of Plastic Surgery 41 (August 1998), which is incorporated by reference herein.
[0019] This invention provides advances over current methods for moving and stretching plastic tissue through the introduction of gradual but unrelenting tension that is adjustable. A system according to this invention is virtually infinitely variable in stretching or closure force and can also be used in restricted areas where other skin closure systems would not fit, including under breasts, at the juncture of the neck and shoulder, and other such areas, and can be scaled up or down as required, using small anchors for ulcer closure and large anchors for abdominal closure. The elastomeric material may vary in thickness and cross section to achieve a near infinite range of tension as required.
[0020] This invention displays several critical advantages over the existing systems. Human skin varies dramatically in elasticity and thickness depending on age and health. Non-healthy patients, such as oncology patients, often present with compounding maladies such as thin, friable and ischemic skin at retracted wounds from procedures, such as a mastectomy, where a retracted incision is further irritated by radiation, which significantly weakens the skin. According to one embodiment of this invention, a variety of skin fixative components match the skin bonding strength to the required moving and stretching force to minimize necrosis and scaring. Additionally, various elastomers may be used in a multitude of ways to create a broad range of moving and stretching forces that match the counter-tractive tensions on multiple planes present in various locations. Unlike prior devices, such as the Proxiderm™ device, an overhead beam is not required, and therefore this invention is capable of providing both linear force and radial force exerted on multiple points.
[0021] According to one embodiment of this invention, dynamic force is used for moving and stretching plastic tissue, providing and maintaining a maximum safe traction pressure or force across a wound margin. The pressure remains below a pressure level that would create localized failure at the wound edge. In this manner, controlled constant and unrelenting tension is created, achieving maximum mechanical and biological yields to move and stretch plastic tissue, including closure of large retracted skin defects.
[0022] Dynamic force is used to draw wound edges together over time, using controlled and relentless counter-traction force. In one embodiment, this dynamic force is created using elastomers that are laced across a wound, allowing rapid removal for dressing changes and uninterrupted visualization of the wound bed during routine cleaning procedures. When tension adjustment is required, it can be accomplished quickly, and the elastomers can include an easily read indicator. Thus, the nursing staff may replace wound dressings and readily reapply the force specified by the surgeon. Utilizing dynamic force to move and stretch tissue offers the advantage of a relentless countertraction force, while allowing for expansion and contraction of the wound site, which greatly enhances patient mobility and is compliant with respiratory movements. In addition, an increased range of traction beyond the elasticity of the skin itself is provided. For example, a range of closure rates of 1.25 to 1.75 cm per day may be averaged over the course of treatment, which is considerably faster (about twice as fast) as the rates achieved using static counter traction methods of the prior art.
[0023] This invention accelerates the reduction in swelling by providing controlled radial pressure, which promotes migration of the edema fluid across the cell wall, enabling faster absorption by the lymphatic system. Thus, when applied to a fasciotomy, devices according to this invention accelerate the reduction in swelling. Traditional fasciotomy procedures provide release of intracompartmental pressure, but provide such release in an irreversible procedure. Methods and devices according to this invention provide controlled pressure release, when applied at the time of fasciotomy, allowing a controlled reabsorption of pressure within the swollen tissue at a level below the threshold that compromises circulation. Retraction of the skin is controlled which reduces the amount of reapproximation required to close the wound after swelling is reduced and compartment pressures are normalized.
[0024]FIG. 1 is a perspective view of the system according to one embodiment of this invention.
[0025]FIG. 2 a perspective view of the system depicted in FIG. 1 during the process of anchor attachment.
[0026]FIG. 3 is a perspective view of the system according to another embodiment of this invention.
[0027]FIG. 4 is an enlarged view of an anchor of the system of FIGS. 1-3.
[0028]FIG. 5 is a side view of the anchor shown in FIG. 4.
[0029]FIG. 6 is a top plan view of the anchor shown in FIG. 4.
[0030]FIG. 7-9 illustrate an anchor and elastomer of this invention at successive stages during the process of elastomer attachment.
[0031] FIGS. 10-13 are perspective views of alternative embodiments of an anchor according to this invention.
[0032]FIG. 14 is a perspective view of an unstretched elastomer according to this invention.
[0033]FIG. 15 is a perspective view of the elastomer of FIG. 14 attached to an anchor and stretched according to this invention.
[0034]FIG. 16 is a perspective view of a wound closure system according to another alternative embodiment of this invention.
[0035]FIG. 17 is a perspective view of attachment of anchors according to yet another embodiment of this invention.
[0036]FIG. 18 is an example of a tension application table used with one embodiment of this invention.
[0037] Methods, systems and devices according to this invention provide a collection of components and techniques for moving and stretching plastic tissue. More specifically, the components are anchors and force applying components specifically including elastomeric components typically connected between and among two or more anchors. Methods, systems and devices according to this invention use dynamic opposing force that is equal to or greater than the elastomeric traction forces of the plastic tissue.
[0038] One system according to this invention includes at least one tissue anchor, which is an element that grips tissue using, for example, sutures, staples, flukes or prongs, adhesives, including surgical glue, or other suitable methods, and at least one elastomeric component. In one embodiment, the anchor is a staple. In a typical embodiment, multiple anchors are attached to the tissue proximate the edges of an open wound. Elastomeric components engage the anchors, providing a force that moves and stretches the tissue. In addition to anchors and elastomers, the system may include a measuring insertion tool and surgical staples. The system can be applied to a patient either during or anytime after a fasciotomy procedure or at any time moving or stretching tissue is required or desired.
[0039] FIGS. 1-3 illustrate a wound closure system according to one embodiment of this invention. A fluke-bearing tissue anchor 20, shown in detail in FIGS. 4-6, has a generally flat body 22 that lies against skin 24, and a hook 26 around which elastomer 28, shown in FIGS. 1-3, may be positioned. Hook 26 of fluke-bearing anchor 20 is perforated by forward eye 30, through which elastomer 28 may optionally pass. Ears 32 extend from hips 33 into opening 34, forward of jam cleat 36 and slot 38. Ears 32 form a staple landing for further stabilization of the forward portion of the anchor, if required.
[0040] Elastomer 28 may be retained by jam cleat 36, as illustrated in FIGS. 7-9. Frame 40 surrounds window 42, through which elastomer 28 may optionally pass. Elastomer 28 may engage jam cleat 36 either from eye 30 or from a subcutaneous presentation through the center opening 34 of anchor 20. Jam cleat 36 may engage elastomer 28 when tensioned and lock elastomer 28 in place when an end of elastomer 28 is relaxed. Jam cleat 36 can also allow elastomer 28 to slip when the load applied exceeds a safe working tension by a margin that is determined by the size of the cleat, the elastomer size, and elastomeric material durometer. Frame 40 can provide a second fail safe release by sizing it to deform through bending when a designated force is applied in excess of the working load limit of jam cleat 36. Deformation of frame 40 causes jam cleat 36 to tilt toward the direction of pull and release elastomer 28, providing release at a safe working load and providing a substantial safe working margin prior to the occurrence of any traumatic failure at flukes 44.
[0041] Fluke-bearing tissue anchor 20 provides a relatively wide area of contact with skin 24, allowing maximum levels of counter-traction to be applied while minimizing localized tissue failures. Fluke-bearing tissue anchor 20 may be attached to skin 24 with at least one staple 46, or by sutures 35 which may pass at least partially through and on one or both sides of slot 38 and around one or both of hips 33 or by surgical skin glue, or other adhesive. Staples may be installed using a surgical stapler, while slot 38 provides access to staple 46 for ease of removal of staple 46. Adjacent to slot 38 is land 48, which stops movement of staple 46 at the rear end of staple travel way 50 that extends between land 48 and indicia 52. Indicia 52 may be a half thickness etch mark used both for part identification and as a visual target by the surgeon for locating the position of the rear staple. Indicia 52 may be chemically milled onto body 22 or may be applied in any other suitable manner. Travel way 50 provides staple 46 unrestricted travel, allowing for the skin contribution and differential stretch between flukes 44 and anchor body 22 that would occur in skin located directly under anchor body 22. Land 48 limits rearward migration of staple 46. Securing the anchor with a staple in this manner counteracts the tip-up force under high load at high stress traction points. Travel way 50 allows body 22 of anchor 20 to slide in a direction roughly perpendicular to the wound, but holds anchor 20 firmly against skin 24.
[0042] Marking instrument 54, shown in FIG. 2, is used to mark skin 24 prior to attachment of anchor 20. As shown in FIGS. 1 and 2, insertion of prongs or flukes 44 having legs 56 and feet 58 into and penetrating the dermal layers of skin 24 holds fluke-bearing tissue anchor 20 firmly in place. Thus, flukes 44 act as grapples, engaging skin 24 because of their shape and angle, and remaining engaged under tension. Feet 58 aid in this grappling function, preventing fluke-bearing anchor 20 from popping out of the skin, and serve as a safety feature, preventing flukes 44 from being driven further into the tissue if direct pressure is applied to anchor 20. Flukes 44 may be disengaged from skin 24 by releasing the tension exerted by elastomer 28 and withdrawing flukes 44 at an angle opposite to the angle of engagement.
[0043] Flukes 44, shown in the drawings, are merely illustrative, and the flukes may have other cross sectional and longitudinal shapes and could conceivably be bent in the process of installation. As an example, one variation of flukes 44 could have wider and longer legs and feet. Flukes 44 could be round rather than square or rectangular in cross section. In another embodiment, the anchor incorporates the staple function so that the anchor includes prongs that bend and capture the skin similar to the prongs on a staple. In this manner, the anchor functions as both an anchor and a staple.
[0044] Marking instrument 54 is designed to fit on a standard scalpel handle and provides a visual reference for the surgeon to puncture skin 24 for insertion of flukes 44 of fluke-bearing tissue anchor 20. Marking instrument 54 is used either with surgical ink or in such a fashion as to produce small depression marks in the skin, which act as guide marks to the surgeon to produce pairs of small puncture wounds with a No. 11 blade or other suitable blade or instrument. This allows flukes 44 of fluke-bearing tissue anchor 20 to be inserted through the dermal layers of skin 24.
[0045] In one embodiment of this invention, such as shown in FIGS. 1-6, each pair of skin anchors provides a controlled dynamic stretching or closure force between about 0 and about 1000 grams. In an alternate embodiment, components of this invention are scaled down and exert lesser force, while another embodiment includes components on a larger scale and therefore exert a greater force. Thus, fluke-bearing tissue anchor 20 and all of the anchor designs described herein may be produced in a variety of sizes. The anchors would typically have a body length of about 5 mm to about 60 mm and a body width of about 2 mm to about 50 mm. The smallest anchors for fine tissue closure would typically have a body width of about 2 mm to about 10 mm and a body length of about 5 mm to about 15 mm. Anchors for general surgical use would typically have a body width of about 10 mm to about 25 mm and a body length of about 20 mm to about 30 mm. In a large embodiment for treatment of abdominal defects, the anchors would typically have a body width of about 20 mm to about 50 mm and a body length of about 25 mm to about 60 mm.
[0046] Flukeless tissue anchor 60, also shown in FIGS. 1 and 2, has a split hook 62, which may act as either a hook around which elastomer 28 is positioned or a jam cleat within which elastomer 28 is captured. Flukeless anchor 60 has at least one slot 64 for receiving a staple or sutures. Alternatively or additionally, flukeless anchor 60 may be held in place with a surgical skin glue or other adhesive. Flukeless anchor 60 may be used when it is necessary to place an anchor near field, or in close proximity to the wound. The term "near field" refers to the area within 2 cm of the incision or wound edge, and is derived from the phrase "near the surgical field." Flukeless anchors 60 are most often used at the wound edge or at the end of the incision and often in opposing pairs. One advantage of flukeless anchor 60 is that puncture wounds for flukes are not required. Therefore, flukeless anchor 60 may also be used when a less invasive procedure is desired.
[0047] As an example, methods and devices according to this invention may be useful in one or more of moving and stretching facial plastic tissue. In one embodiment, flukeless anchors are provided in a smaller format and used for curing a facial defect. In this manner, facial defects may be treated in a less invasive manner since puncture marks are not required or are limited to those made by staples. In this embodiment, reduced size flukeless anchors may be attached to the skin using an adhesive, surgical glue, or other suitable method.
[0048] In one embodiment, flukeless tissue anchor 60 is used in conjunction with a viscoelastic suture, such as a suture made of material such as Silastic™ or latex. Generally, the viscoelastic suture is inserted outside of the wound margin and extends across the wound, exiting the skin outside the opposite wound margin. Flukeless tissue anchor 60 may be used to capture the suture as it exits the skin, linking the system to the suture. In this embodiment, flukeless tissue anchor 60 acts as a grommet, removing the point load from the suture exit hole to reduce the occurrence of localized failures, and also allows adjustment of the tension across the wound. Reducing localized failures also reduces scarring. This combination of a viscoelastic suture and an anchor creates a linear plane of pull, so that the skin is moved and stretched and the wound is reduced across the shortest possible distance, and it is unnecessary to follow the contour of a body cavity. This is important in situations such as in the case of severely emaciated patients with a retracted abdominal wound and in cases where a large cavity exists after removal of a tumor. In another embodiment, such a suture is used with at least one fluke-bearing tissue anchor. One example of a suitable suture is described in U.S. Pat. No. 5,895,413 to Nordstrom, the entirety of which is incorporated by reference herein.
[0049] In an alternate embodiment, this system is used with a through and through suture, which is a suture through all layers: skin, subcutis, fascia, muscle and peritoneum. In this embodiment, a through and through suture is secured to an anchor in order to distribute the load.
[0050] Elastomer 28, also shown in FIGS. 1-3, may be threaded through eye 30 of hook 26 of fluke-bearing tissue anchor 20, may pass around hook 26 of fluke-bearing tissue anchor 20 or around split hook 62 of flukeless anchor 60, or, may be gripped by jam cleat 36 or split hook 62. As illustrated in FIG. 1, elastomer 28 may be "laced" through a series of anchor hooks by passing around hooks of each anchor unit on the wound margin, or edge. Elastomer 28 may engage jam cleat 36 (passing first through window 42) or split hook 62 to terminate the lace end. As illustrated in FIG. 3, elastomers 28 may be used with sets of paired anchors. Opposite ends of elastomer 28 are threaded through eye 30 of hook 26 of fluke-bearing anchor 20, and then also through window 42 and jam cleat 36. This method allows for the control of unbalanced wound tension and is desirable where different closure forces or alternate pull solutions are required. Use of elastomers 28 with the anchors as described allows the device to act in a biaxial plane, providing treatment of wounds on curved body surfaces such as the feet.
[0051] Elastomer 28 may be made from virtually any elastomeric material acceptable for use near open wounds, including, but not limited to, latex or silicone rubber, natural rubber, GR-S, neoprene, nitrile-butyl-polysulfide, ethylene-polyurethane, polyurethane, or any other suitable material which exhibits the property of exerting a return force when held in an elongated state. Elastomer 28 provides a dynamic opposing force equal or greater than the natural occurring elastomeric traction forces of the skin. Elastomers of this invention may be formed in tubes with typical external dimensions of about 0.125 inch, however, alternative shapes, sizes and strengths may be appropriate in some situations. Elastomers of this invention are generally not endless loops but rather are lengths of a single strand, sometimes called a "monostrand," and may be either solid or hollow. In some instances, multiple strands or endless loops or bands may be used. Significantly, the elastomers used in practicing this invention may be secured to an anchor component at virtually any point along the elastomer, providing variable tension within the elastic limits of the elastomer.
[0052]FIG. 10 illustrates an alternative embodiment of a fluke-bearing tissue anchor. This alternative fluke-bearing tissue anchor 66 has hook 68, which is perforated by eye 70. Jam cleat 72 projects from body 74 and a stabilizing tail 76 projects from body 74 in the same plane and carries keyhole cleat 78. Body 74 also has staple apertures 80. FIG. 10 shows one end of elastomer 28 terminated using jam cleat 72 and positioned by eye 70 of hook 68. Another elastomer end is secured in keyhole cleat 78. Staples 46 are received in staple apertures 80 and assist flukes 82 in holding fluke-bearing anchor 66 in place. Ballast staple 83 is inserted across stabilizing tail 76 and counteracts the tip-up force under high load at high stress traction points. Ballast staple 83 allows stabilizing tail 76 to slide in a direction roughly perpendicular to the wound, but holds fluke-bearing anchor 66 firmly against the skin. Elastomer 28 is locked into keyhole cleat 78 of fluke-bearing anchor 66, allowing elastomer 28 to encircle an object or limb and allowing one end of elastomer 28 to be entrapped in jam cleat 72 and the second end of elastomer 28 to be trapped by keyhole cleat 78. In this manner, a single anchor and an elastomer may provide radial tension.
[0053]FIG. 11 illustrates another alternative embodiment of a fluke-bearing tissue anchor of this invention. Alternative fluke-bearing anchor 84 has a generally flat body 86 that lies against the skin. Hook 88 of alternate fluke-bearing tissue anchor 84 is perforated by eye 90 through which elastomer 28 may optionally pass, and is split by cleat 92, which may retain elastomer 28. Elastomer 28 may pass through eye 90 and be retained by cleat 92. Alternative fluke-bearing anchor 84 also has flukes 94, each of which include a leg 96 and a foot 98. Alternative fluke-bearing anchor 84 may be attached to the skin with at least one staple or by sutures passing through slots 100, or with surgical skin glue or other adhesive.
[0054]FIG. 12 illustrates yet another embodiment of an anchor of this invention. Tractor anchor 102 has a generally flat body 104, the edges of which are perforated by alternating slots 106 and holes 108. The spacing of slots 106 and holes 108 accommodates all standard skin staples. A staple may be placed through a slot and over narrow arm 110, and projections 112 prevent staples from sliding beyond narrow arm 110. Tractor anchor 102 has flukes 114, including legs 116 and feet 118.
[0055] Tractor anchor 102 also has two cleats: front hook 120 and rear cleat projection 122. Front hook 120 is perforated by eye 124 through which elastomer 28 may optionally pass, and has cleat 126, which may retain elastomer 28. Rear cleat projection 122 is perforated by rear eye 128, through which elastomer 28 may optionally pass, and is split by cleat 130, which may retain elastomer 28. This double cleat design allows use of two rows of anchors on each wound margin since one or more elastomers may be attached at the front hook and rear cleat. In this embodiment, tractor anchor 102 is placed at the wound margin, while another anchor, including a tractor anchor or any of the anchors described herein, is placed at a greater distance from the wound, forming two rows of anchors. This alternative embodiment further dissipates load across the anchors. FIG. 13 illustrates yet another alternative embodiment of a fluke-bearing tissue anchor that includes a jam cleat and a hook perforated by an eye.
[0056] Anchor 20 and any of the other anchors described and illustrated herein may be fabricated from metal, plastic or other suitable materials. For instance, the anchors may be made by chemically etching 0.015 inch sheets of 304 stainless steel using a bookmatched two side photo resist chemical milling process to form appropriately-shaped anchor blanks that are then bent into their frished shape. This anchor is tab-less free etched and the logo and identifier marks are half etched in a single process. The photo resist mask is stripped and the anchor is tumbled in abrasive media for fine de-burring before final cleaning and processing.
[0057] In one embodiment, the anchors are formed from plastic, or other suitable material. In another embodiment, the anchors are disposable. In yet another embodiment, disposable anchors are attached to the skin using a pressure sensitive adhesive with peel off backing that is attached to the bottom surface of the anchor component.
[0058]FIGS. 14 and 15 illustrate an elastomer of this invention having an integral tension indication feature. Indicia 132 on elastomer 28 are used to indicate tension, and may be either marked (e.g. with colorant such as ink, paint, stain, dye or other colorant) onto the elastomer, or may be a raised ring, or annular depression, or any other suitable mechanism. In one embodiment, indicia 132 are spaced at a distance of one centimeter. Among other ways of placing indicia on elastomer 28, equally spaced indicia could be marked on elastomer 28 using a pen or other writing instrument by reference to a ruler or inserted through slots in an INCRA� marking rule or other device having spaced apertures. The indicia 132 are spaced at a distance L1 when the elastomer is in a resting state. When the elastomer is stretched, the distance between adjacent indicia 132 increases to L2. When the appropriate amount of tension to be applied is determined, the distance between the elastomers, L2, is measured and recorded so that it may be reproduced accurately after removal of the system for any reason, such as changing the dressings. Measurement of the difference in the distance, L1/L2, can enable the surgeon to determine how much tension is being applied by reference to a previous determination of the force exerted by a like elastomer (same type and size) stretched the same distance. Such information can be set forth in a table, as illustrated in FIG. 18, to which a surgeon can refer in order to convert a measured distance into an amount of tension.
[0059] In yet another embodiment of this invention, illustrated in FIG. 16, a dynamic wound closing force is applied to a wound by attaching a loop of suture 134 to the wound margin 136 with small anchors or clips 138. Wound margins 136 are drawn together by applying force to suture 134, as shown in FIG. 16, along the length of the wound. This alternative is shown in FIG. 16 using medical tape 140, further described below, but may be accomplished using any of the anchor attachment methods described herein. Force is applied by engaging suture 134 with opposite ends of a bow 142, which may be wood, plastic, steel, or other suitable material that can be deformed into a bow shape but that seeks to straighten, thereby further separating the bow ends 144 and 146.
[0060] This invention may be applied in a clinical setting using local anesthetic. The surgeon evaluates which direction the skin needs to be contracted to facilitate closure. The wound length is measured in order to estimate the number of anchors required. The appropriate spacing of anchors will depend on the location and nature of the wound and other factors. A long wound on a human forearm might, for instance, use anchors that are placed about every three centimeters. A skin marker is used to draw a line about one centimeter from the margin, or edge, of the wound. Anchors are then installed, generally starting at the center of the wound, and typically in opposing pairs. The surgeon may choose a flukeless tissue anchor for use near the incision. A flukeless tissue anchor may be installed using a single surgical staple for light loads, or multiple staples or sutures for higher loads.
[0061] Alternatively, the surgeon may choose to install a fluke-bearing tissue anchor, which is generally used at a distance greater that two centimeters from the incision margin or edge and in circumstances where the traction will be applied beyond the anchor range of a flukeless tissue anchor, or one of the other anchors described above. A fluke-bearing tissue anchor may be used when it is desirable to avoid eversion of the wound edges, which may interfere with healing. Marking instrument 54 is used to provide guide marks to the surgeon for insertion of flukes 44 of fluke-bearing anchor 20 into skin 24 and stab wounds are made with a suitable blade, such as a #11 blade. Fluke-bearing tissue anchor 20 is then stapled, sutured or glued to secure it in place. If secured using at least one staple, a staple 46 is installed across travel way 50, allowing movement of anchor 20, thus preventing flukes 44 from digging into the sub-dermal layers of the skin, which can result from high counter-traction loads presenting off-axis thrust beyond the anti-torque forces provided by the dermis. A second staple may be installed across ears 32 if an increase in stabilization of the forward portion of fluke-bearing tissue anchor 20 is required.
[0062] The wound bed is dressed with a either a wet, dry, or other suitable dressing 37 (shown in FIG. 1). One such suitable dressing is Duoderm�, available from Smith & Nephew, or Tegaderm�, available from 3M. Elastomers 28 are applied, either in a lace fashion, as illustrated in FIG. 1, or by connecting two opposing anchors with one length of elastomer, as illustrated in FIG. 3. Additionally, the length of elastomer may wrap around the body part. Elastomers 28 apply a relatively constant force over a relatively large distance. The laced version of elastomers 28 is used when even amounts of tension are desired along a shear plane, such as is typically desired with a long, straight incision. A length of elastomer between two opposed anchors is used individually or in multiples when an irregularly shaped defect requires varied forces along more than one thrust plane. This would be typical of a Z-plasty, an L-flap incision or an incision not on the transdermal plane. A single elastomer 28 may also be used to encircle an object or wound and create radial tension. Elastomers 28 may be unlaced or uncleated repeatedly to allow for easy dressing changes, re-positioning, and re-tensioning.
[0063] In an embodiment of this invention used in the closure of a fasciotomy, this method of gradual wound closure eliminates the need for later suturing because this device approximates the edges of the wound, allowing the wound to heal as if sutures were in place. Elimination of delayed closure provides treatment in a single surgical intervention.
[0064] In an alternative embodiment of this invention, anchors, including any of the anchors described herein, are mounted on medical tape, such as pressure sensitive adhesive backed tape, as shown in FIG. 17. In this embodiment, the tape is attached to the patient at the wound margins. In another embodiment, the cleats are manufactured with an integral tape anchor feature to allow them to be sandwiched between two layers of medical tape. Such an integral tape anchor feature may be a structure having a large surface area with many through holes, such as a honeycomb grid, or a circle, or other suitable structure.
[0065] The system and methods of moving and stretching plastic tissue according to this invention are not confined to the embodiments described herein but include variations and modifications within the scope and spirit of the foregoing description and the accompanying drawings. For instance, the scale of the components of the invention can vary quite substantially depending on the nature and location of the tissue with which the invention is used. The configuration of the anchors can also be varied for the same reasons and for aesthetic reasons. While most of the elements of the illustrative embodiments of the anchors of this invention depicted in the drawings are functional, aspects of the shape and appearance of the illustrative embodiments are nonfunctional and ornamental.
[0066] The materials from which the components used in practicing this invention are made can be those described above as well as others, including materials not yet developed that have appropriate properties of strength, elasticity and the like that will be apparent to those skilled in the art in light of the foregoing. For instance, useful materials generally must be sterile or sterilizable and hypoallergenic. The illustrated components are typically intended to be reusable, but the invention could also be practiced using disposable components, such as, for instance, metal or plastic anchors supplied in a sterile package and optionally having pressure sensitive adhesive covered by a peel-off film on one surface of the anchor to protect the adhesive until the anchor is to be used.
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|U.S. Classification
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|International Classification
|Cooperative Classification
|European Classification
|Dec 14, 2007
Owner name: CANICA DESIGN, INC., CANADA
Free format text: NUNC PRO TUNC ASSIGNMENT;ASSIGNORS:BELL, MICHAEL;LEE, JAMES;LEE, LEONARD;AND OTHERS;REEL/FRAME:020248/0027;SIGNING DATES FROM 20060619 TO 20060717
|Mar 23, 2012
|Fee payment
Year of fee payment: 4


text:
Parameter in Java
Hi people
I would like create a method but i don't know how much parameter i can have in my method, how much parameter can i have in my method?
every parameter are pass by value in java.
The real thing pass when we passing a parameter is bit value of parameter.
When we pass a reference of a object then the bit value of reference is pass and
reference parameter is now pointing the object which is pointing by the passing reference.
For example
String s = new String("abcd"); //here s is a reference of String object
f(s); //and here a function f is calling and reference s is pass
// here is definition of function f
public void f(String s1) {
//some code here
//now the bit value of reference s1 is same as reference s
and reference s1 is also pointing the object which is pointing by reference s
> all descendants from Object are passed by reference
No, the reference to an Object is passed by value. In your example, the doesnothing reference s is a copy of the reference s in main, that is why assigning it to "abc" does not change where the main reference s points to (the String object "def").
Both of the s refer (at the start of doesnothing) to the same String "def" though, so could modify the same Object (but Strings in Java are immutable, so not in this example).
I know, I know. [i]References[/i] are passed by value, but the object itself is passed by reference.
I'm not completely Java illiterate, you know? ;) Give me some credit, here.
Besides, when someone asks "Can you use parameters in Java," I want to keep it simple.
You may be interested in going through the [url=http://java.sun.com/docs/books/tutorial/]Java Tutorial[/url], especially the part on [url=http://java.sun.com/docs/books/tutorial/java/nutsandbolts/variables.html]variables[/url].
You can't choose to pass an object by reference or by value in Java. All primitive types are passed by value, all descendants from Object are passed by reference. Assignment to parameters in a method doesn't affect the references or values outside of the method:
void doesnothing(String s) {
s = "abc";
static void main(String[] args) {
String s = "def";
System.out.println(s); // yields "def"
There is no equivalent to the 'reference' (&) and 'dereference' (*) operators in C. The closest you can come to a pointer is probably an array.
void doessomething(String[] s) {
s[0] = "abc";
static void main(String[] args) {
String[] s = new String { "def" };
System.out.println(s[0]); // yields "abc"
Hope this clarifies,
Your second example more exactlier:
void doessomething(String[] s) {
s[0] = "abc";
static void main(String[] args) {
String[] s = new String[] { "def" };
System.out.println(s[0]); // yields "abc"
You can have so much parameter what you need.
If you do not need any e.g.:
public void myMethod()
If you want to have only one parameter e.g.:
public int myMethod(int p1)
If you want to have five parameters e.g.:
public double myMethod(int p1, double p2, String p3, int p4, int p5)
And so!
Message was edited by: pelz
Message was edited by: pelz
Do you know if i can use parameter for reference in java?
I think this link helps you: http://java.sun.com/docs/books/jls/second_edition/html/typesValues.doc.html
Do you think about the reference type as in C++?
int myMethod(int& i1) // ???
I think, this syntactic is not possible in Java. But the class objects are reference type automatical, if they are parameters in a method.


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All posts tagged "Paul Trapani"
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2006 BMW M3 Repair and Maintenance
A guide to problems, costs, maintenance and repair for your 2006 BMW M3
- Clutch Replacement $1,228 - 1,760
- Brake Pad(s) Replacement $136 - 350
- Oil Service $74 - 139
- Starter Replacement $458 - 764
- Exhaust Manifold Replacement $1,205 - 3,245
- Ray & Dana's Inman Auto Care (732) 856-5054 | 3.46mi
- 12 Volt Doctor (718) 412-9553 | 2.98mi
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2006 BMW M3 Problems
A fluid leak may develop from one or more power steering hose. When a leak is being repaired, it is not uncommon for multiple hoses to be replaced.
2006 BMW M3 Questions
On cold starts knocking sound that seems to emanate from vanos unit.After 5 minutes of driving the sound subsides and hard to detect.Any thoughts?
Can I use reg unleaded
2006 BMW M3 Recalls
In a crash that deploys the driver's front air bag, the inflator of the air bag can rupture, causing metal debris to strike vehicle occupants. Dealers will replace the front driver's air bag module free of charge to correct the concern.
Upon deployment the passenger airbag inflator could rupture, increasing the risk of personal injury. BMW dealers will replace the affected airbag inflator modules to correct this concern.
2006 BMW M3 Reviews
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Comments about 'Is America in decline? That may be the wrong question to ask'
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I, along with the rest of the nation, have watched in horror this past week as the details of the J
There's this place near our home called Kiddie Land. It's sort of this epic little corner nearish to the city that, for 80 some years, has boasted good times for kiddos. Think wooden roller coasters from the '30s, a wooden carousel, and rides that make you feel somehow like you are on a boardwalk in Atlantic City or someplace like that in the '20s.


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- GENERAL® GRABBER AT2GRABBER AT2 All Season / All Terrain Tires by General® . This tire is available for most light truck applications, and brings aggressive all-terrain traction - for all terrain and all weather conditions. But unlike most all-terrain...$113.00 - $267.00 (ea)
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text: We will be flying in to San Jose and renting a car for a week. Plan is to drive to La Forunta, spend an adventurous 3 days, then drive to Tambor/Cabano/Malpais to vegetate on the beach. On day 7 drive back to San Jose, day 8 fly home. This seems like a lot of driving, but budget-wise better than flying. The big question is, do we need a 4x4 to do this? We will be travelling the first week of June.


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San Isidro hotels
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Looking for a place to stay in San Isidro? Well, Orbitz has 84 hotels, most of which rate highly for Hotel Staff and Location.
No matter what your traveling style, you're likely to find a hotel that suits your needs. And you can always stay in the heart of the action — Montaña Amarilla, mgcas and Playa de la tejita are calling your name.Arts and culture in San Isidro
Biblioteca Pública de San Isidro Centro Cultural and Libreria Gaia offer a taste of culture and learning.Best times to visit San Isidro
If you're planning a trip to San Isidro, consider visiting in June, May and September. Orbitz offers great deals 365 days a year, but during these months, you'll save the most — 33%, 33% and 31%, respectively.Where to eat in San Isidro
After shopping or sightseeing all day, a hearty meal may be in order. Break bread and rest your tired feet at Los Roques, Placeres and Restaurante la Langostera.Nightlife in San Isidro
After the sun goes down, shake a tail feather or grab a drink in San Isidro. Friends Bar, El Nautico Terrace and Oasis Pool Bar & Restaurant are good places to belly up to the bar and order a cold drink or chat with the locals — or both.Get outdoors in San Isidro
Not all of San Isidro's attractions are indoors. Spend some time at Montaña Amarilla. Visiting Montaña Amarilla, too, is a good way to get outside.
Activities in San Isidro
Make sure you leave time for play while in San Isidro!
Peluquería Consmar offers a serene environment to visitors looking for a little pampering and relaxation.Where to shop in San Isidro
Centro Comercial San Sofé is a shopping hub in San Isidro. The accessories at Oro Efectivo 3000 will put a finishing touch on all kinds of looks.
KS Computer Systems offers up the latest tech to window shoppers and serious enthusiasts.Where to stay in San Isidro
Tenerife South Airport is the main hub for flights into San Isidro and the surrounding area.
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Featured San Isidro Hotels
1 Domus Selecta Rural Cortijo La Alberca
Camino De Huebro S/n
This characterful, converted farmstead set in the foothills of the Sierra Alhamilla provides an ideal venue for a break in beautiful rural Andalusia. The Hotel Rural Cortijo La Alberca lies in the...


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Leather Flight BagCrafted for the frequent traveler, this top-grain leather bag is a must have. Exuding lots of style and sophistication, the leather flight bag is perfect for trips of all kinds. The bag offers an optimum amount of storage space for flexible portability. Cargo pockets on the side provide quick access, while being secured with a robust belt . A zippered compartment on the opposite side offers extra storage space for all those last minute essentials. The shoulder strap is adjustable for your carrying comfort. The bag is compact with these dimensions: 19"l x 12"h x and 9"w. Learn More
Regular Price: $180.00
Special Price $90.00
Leather Smartphone Case & Wallet ComboOur multi-purpose crossbody wallet is made of the highest quality leather. Convenient adjustable and detachable shoulder strap and front pocket which is secured by a lock. Zip around wallet has an I.D. window, zip pocket, credit card holders, and a back slide pocket. 7"L x 5.5 H" x 1.5"D. Imported. Learn More
Regular Price: $99.00
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Leather Crossbody BagOur beautifully crafted western inspired handbag features a unique raw edge flap, adjustable shoulder strap, zip top for security, back zip and interior zip pockets. It's casual simplicity in the most modern way. 13"L x 12.5"H x .5"D. Imported. Learn More
Regular Price: $199.00
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Wool Felt Floppy HatEverybody wants a new hat and the current rave is the round crown floppy. This one is made of 100% wool with a black and white houndstooth band. To accentuate its fabulous shape and detail, we've added a side rosette. The 31⁄2" brim is the perfect size to flatter your face. Learn More
Regular Price: $110.00
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The Classic Derby HatThe derby which is characterized by its stiff, rounded crown and narrow brim is now popular among all ages. It features a satin band, feather, and hatpin, and can be worn in a dressy or casual mode. Satin lined and beautifully crafted. Stylish on women as well. Imported. Learn More
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Frayed Blanket ScarfYou'll love the multitude of ways that you can wear this great looking southwestern inspired blanket scarf. It's 26" x 73" with fray edges and a geometric pattern in subtle earthtone hues. 100% acrylic. Imported. Learn More
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Cowboy Hat with Concho BandOur new 100% wool felt cowboy hat is exceptional. Designed with a genuine leather concho band, it's a top of the line stand-out. Great look for women, too! Learn More
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Wool Felt Cowgirl HatTurquoise stones on the faux leather band make this gaucho outstanding, with a leather chin cord. 100% wool with a tear drop pinched crown and 3" brim. Learn More
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Preschool Classes and Programs
Sign up to receive our monthly e-mail newsletter featuring programs, classes, and events just for youth!
Preschool Living and Learning (PDF 949.84 KB) Upcoming classes, events and programs just for preschool-age children and their parents!
FREE Classes and Programs for Preschoolers
Sports and Fitness
- Basketball Future Stars
- Turf Tigers Indoor Soccer Classes and Leagues for Preschoolers
- Sport Shorties Fall Ball and Soccer Sport Shorties
- Free-Time Play for Children 5 Years and Younger
Music and Art
- Music Classes for Young Children at the Allison-Jukebox Community Center
Living and Learning
Science and Nature
- Nature's Music - create your own naturescape and make your own music
- Preschool Garden Club
- Tots on Trails-a short hike on the Jackson Creek Trail with discoveries geared toward preschoolers


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$ 34.00
Keep your drinks cold or hot with our personalized collapsible koozies.
Our koozies are the perfect accessory for entertaining, tailgating, or when your on the go. Great for party or wedding favors!
Fits 16oz. water bottles, longnecks, and cans. Best of all it folds flat so you can easily take it anywhere.
*Each item is made to order. Average turnaround time is 10 business day. For current turnaround times please, click here.


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This image released by the NASA of Pluto`s haze layer shows its blue color in this picture taken by the New Horizons Ralph/Multispectral Visible Imaging Camera (MVIC). It is thought to be similar in nature to that seen at Saturn's moon Titan.
At least 50 vehicles were part of Thursday's pile-up that claimed 3 lives and left 14 people injured in the Vitinya tunnel, a few dozens of km away from Sofia, September 08, 2015.
Albanian special police and a helicopter secure the area around the Elbasan Arena prior to the UEFA EURO 2016 qualifying soccer match between Albania and Serbia in Elbasan, Albania, October 08, 2015.
Italian actress Claudia Cardinale has just been awarded an honorary degree by the National Academy for Theatre and Film Arts (NATFA) - October 08, 2015.
Italian actress Claudia Cardinale has just been awarded an honorary degree by the National Academy for Theatre and Film Arts (NATFA) - October 08, 2015.
A Jew from Romania, back-dropped by Romanian Honor Guard soldiers, pays respect for the victims during a ceremony commemorating the Romanian Day of Holocaust, held at the Holocaust Memorial in Bucharest, Romania, 08 October 2015.
Q: What does an Irishman get after eating Italian food?A: Gaelic breath.... read
"At last! I've taught the cat to use the toilet sitting on a newspaper," a woman tells her husband, exalted."Now you'll have to teach her to to wait until ... read
"The biggest risk in this situation is that those fighters, thousands of them already being there, including those who migrated from Russia, will return and will commit their dark deeds in our country. These are the risks we are doing our best to avoid, [and I am] certain we will ... read
"The Greek government has found far more open ears [here] than in Brussels for the need for there to be a fair resolution of the crisis and a necessary reduction of the unbearable and unsustainable public debt that has accumulated all those years." Greek Prime Minister, as quoted by ... read
More and more migrants arrive in Croatia on alternative routes to enter the European Union in recent days. Serbia`s border with Croatia has become the latest flashpoint in Europe`s refugee crisis as migrants sought alternative routes to Western Europe after Hungary slammed its doors shut. Hungary on 15 September sealed the last gap in the barricade along its border with ...
Bulgaria Boasts 92 % Absorption Rate of EU Funds - PM Borisov
Hungary Detains Fourth Bulgarian over Dead Migrants Found in Truck in Austria


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Registration takes less than 1 minute.
European regulators may seek concessions from FedEx such as asset sales as part of its deal to acquire TNT Express, according to multiple media reports.
The Atlanta, Ga.-based shipping and logistics provider opened its first multi-client hub in its network to provide medical device companies comprehensive logistics services.
The logistics provider launched a new rail connection between Germany and the Netherlands Wednesday.
The fund will be held and administered by the Seamen's Church Institute, North America's largest mariners' service agency, following the structure put in place by TOTE.
The entire investigation into the loss of TOTE Maritime Puerto Rico ship will take 12-18 months, but the NTSB will release findings on an "as needed" basis in advance of its final report.
The national mail carrier of Singapore and aspiring global logistics provider has agreed to purchase a 71.1 percent share in Jagged Peak, Inc. for $15.8 million.


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Air your grievances before you hit the weekend.
Released Albums
Unreleased Albums
Top 10 Songs of the Week (8/21)
YACHT announces new album, premieres "I Thought the Future Would Be Cooler" — listen
The follow-up to 2011's Shangri-La is set for October.
Nerdy Show celebrates 200 episodes with "The Oral History of Video Games", featuring "Weird Al", YACHT, Chris Carter, and more
Nerdy Show's flagship podcast hits a big milestone.
TBD Fest 2014: The 9 Most Memorable Sets
Northern California sure sounds better to me than October in Texas.
YACHT share new song "Works Like Magic" — listen
LA electropop group prep their new EP, Where Does This Disco?.
YACHT release new song "Where Does This Disco?" — listen
Electropop outfit sign with Downtown Records and also launch their own sunglasses line.
Sacramento's TBD Festival reveals 2014 lineup
Justice, Explosions in the Sky, Blondie, Kurt Vile, The War on Drugs, and more to play Sacramento festival.
YACHT announces 2014 North American tour
The Los Angeles-based group hits the road this summer.
Moogfest 2014: Finding a Future in Asheville
No matter where time may take us, Moogfest will be there.
YACHT's Claire Evans: Creating Without Boundaries
The eccentric singer discusses Moogfest, science-fiction, and music in the future.
The Hudson Project reveals inaugural lineup
Kendrick Lamar, Modest Mouse, The Flaming Lips, Flying Lotus, and more.
Moogfest expands 2014 lineup: M.I.A., Flying Lotus, Pet Shop Boys, Bradford Cox, and Nick Zinner
Asheville festival announces additions to daytime and nighttime programming.


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Tour the Berkeley Campus
Walking Tours for Individuals and Families
UC Berkeley Visitor & Parent Services offers several types of free walking tours of the campus almost every day of the year. Led by expert student ambassadors who know the university and the nuances of student life, a campus tour is ideal for students interested in attending Berkeley, tourists, nostalgic alumni, and anyone wishing to learn more about the university. Tours are conducted rain or shine.
These walking tours are for individuals, families, and parties of up to nine people. If you are a school group or organization, a party of 10 people or more, or if you wish a private tour, please go to the Group/ Private Tour Page for more information.
All tours require an online reservation. The online calendar includes all the free walking tours. Please read the descriptions below before making your reservation to ensure you are reserving the correct tour. If the name of your tour does not appear on the date of your choice, it means the tour is not being offered that day or time or that it is full.
Weekday Tours (Cal Tour Weekday)
Non-holiday weekday tours begin at 10:00 am (and 1:00 pm in April) at the Visitor Center in 101 Sproul Hall.
To reserve a tour, scroll to the bottom of the page and click on the button *Make a Reservation*.
Weekend Tours (Cal Tour Weekend) and Tours on University Holidays
Tours on weekends and holidays (see list below) begin at the Campanile, also known as Sather Tower, located in the heart of the UC Berkeley campus. Saturday and holiday tours begin at 10:00 am (and 1:00 pm in April) and Sunday tours begin at 1:00 pm.
Tours will be offered on the following university holidays:
- Veteran's Day
- The day after Thanksgiving
- Martin Luther King, Jr. Day
- Presidents' Day
- Memorial Day
- Independence Day
To reserve a tour, scroll to the bottom of the page and click on the button *Make a Reservation*.
California Memorial Stadium Tours
In partnership with Cal Athletics, Visitor & Parent Services offers tours of California Memorial Stadium and the Simpson Center for Student-Athlete High Performance.
Fall 2015 tours will be offered on Fridays at 12:30 pm and on Sundays at 11:00 am, starting on September 25.
Tours are open to the general public, and fans from visiting institutions are encouraged to participate. The one-hour tour covers a variety of points of interest, including the Lisa and Douglas Goldman Plaza, the Haas School of Business Innovation lab (iLab), the Hall of Fame room, and the Simpson Center.
The tour is free, space is limited, and reservations are required.
To reserve a tour, scroll to the bottom of the page, and click on the button *Make a Reservation.*
Newly Admitted Student Tours
In April, special tours are offered for newly admitted students. Information will be posted in March 2016, when admissions decisions are sent out.
Undergraduate Engineering Tours
Visitor & Parent Services offers a limited number of engineering tours during the academic year for prospective and newly admitted undergraduate students and their families. Engineering tours are not offered during the summer. Fall 2015 tours will be offered on Mondays and Fridays at 2:00 pm from October 5-December 4.
The 1 1/2 hour tours are led by specially trained campus ambassadors. The tour includes visits to several College of Engineering buildings, and includes information on teaching; research; and student projects, services, and groups. The engineering tour provides some general campus information, but does not replace the general campus walking tour, for which separate reservations are required.
Space is limited, and reservations are required.
To reserve a tour, scroll to the bottom of the page and click on the button *Make a Reservation.* If you do not see an engineering tour on the calendar grid it means that all the tours are full.
Other Campus Opportunities on the Day of your Visit
- Attend the 9:00 am admissions information session for prospective students offered by the Office of Undergraduate Admissions. Space is limited and your registration is appreciated . Please stop by the Visitor Center in 101 Sproul Hall, sign in for your tour, and staff will direct you.
- Attend a UC Berkeley class. Available during the fall semester only. Visit the Class Pass page of our website.
- Tour the residence halls. Information and online reservations are available on the Cal Housing website. Residence hall tours are not offered during the summer.
Reserving a Tour
Clicking on the button below will take you to the tour calendar, where you may reserve your tour. Several types of tours are listed on the calendar. Please be sure you are reserving the right tour. If you do not see your tour listed on the date you wish to take a tour, it means that the tours on that date are full or are not being offered.


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Patriots vs. Panthers Tonight on WBLM [VIDEO]
When the New England Patriots play the Carolina Panthers tonight it will be the closest thing to a real game as you will see in the preseason.
When the New England Patriots play the Carolina Panthers tonight it will be the closest thing to a real game as you will see in the preseason.
Tennis legend John McEnroe performs a high energy cover of Nirvana's 'Territorial Pissings.'
Rick Porcello made his return to the mound in the series finale against Chicago and so to did his dominant sinker ball that allowed him to pitch 7 scoreless innings in a Red Sox 3-0 win.
Foo Fighters' Dave Grohl welcomed an audience member onstage and briefly chugged a beer with him to celebrate the man's 50th birthday.
As we inch closer to New England Patriots opening night, Thursday, September 10th, the NFL Network keeps putting out promo trailers for their opening night eve show "Do Your Job". It's the behind-the-scenes look at the Super Bowl run on last year...
Justin Wilson who suffered a head injury during an Indy Car race Saturday at Pocono Raceway succumbed to his injury on Sunday.
The numbers don't add up, as the New England Patriots sign a new player to the roster they could potentially lose two more.
Check out the booty-ful new video for Buckcherry's single 'Tight Pants.'
Wide receiver Reggie Wayne was a thorn in the side of the Patriots for many years, now New England might add him to their roster.
AC/DC kicked off their North American tour last night (Aug. 22) in Foxboro, Mass.


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This was a big group project that we did during the time on Hyper Island Karlskrona. We were a group of 12 working with this for 4 weeks. The brief that we got from the client was to create 10sec category introduction films for the Nordic Game Awards 2013.
The category films introduce the following six award categories:
- Best Nordic Children's Game
- Best Artistic Achievement
- Best Indie Sensation
- Best Nordic Innovation Award
- Best Nordic Game of the Year
Music is made by David Ketikidis
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By Jordan Rau
Thinking about getting a mammogram in the Dallas-Fort Worth area? You might check carefully because the cost can vary from $50 to as much as $1,045.
How about an initial routine gynecological exam? Around Phoenix, those prices can range from $72 to $388.
According to an analysis released Wednesday, it can pay to shop around for women's health care, with mammograms and other routine services often costing far more in one office than in another. Continue reading